management of poisoning Flashcards
What are the general principles n Poisoning management?
► Poison Stabilization and Evaluation
► Decontamination
► Poison elimination [ antidote Administration]
► Nursing care
► Psychiatric care
this examination should be done on all patients to find out immediate abnormal measures which need to be stabilized starting with vital signs, conscious level and pupil size, skin temperature, pulse oximetry, and electrocardiogram.
Initial investigation or Initial screening
ABCD of RESCUCITATION
A:Airway
B:Breathing
C:Circulation
D:Depression
It is very important and can be obtained from the patients if they are alert and conscious.
History of the present illness
If the patients are comatose or cannot give their history, in such situations, history can be taken from collateral information from family, friends, ambulance crew, or medical records looking for past psychiatry illness, previous history of suicide or drug abuse, chronic medication, etc.
History must include time, route of entry, quantity, intentional or accidental exposure, availability of drugs at home, and if any member of the family has chronic diseases (hypertension, diabetic, etc.) and missing tablets or any empty pill bottles or other material was found around him.
It may give clues regarding the substance which has been abused and toxidromes.
Physical examination of poisoned patients
It occurs in the case of overdose of anticholinergic agents, antihistamines, TCAs, atropine, scopolamine, and phenothiazines.
Red and flushed skin
It occurs in the case of sympathomimetics (cocaine), cholinergic agents (organophosphates), central hallucinogens (lysergic acid diethylamide (LSD) and phencyclidine) and salicylate toxicities
Pale and diaphoretic skin
Central nervous system Depression may be caused by the following:
Anticholinergics
Antidepressants
Antipsychotics
Lithium
Cholinergic beta blockers
Clonidine
Sedative-hypnotics.
Central nervous system Agitation [nervous excitement]
Sympathomimetics
Anticholinergics
Salicylates
Central hallucinogens
Drug withdrawal states
Carbon monoxide
Hypoglycemic agents
Heavy metals
Common drugs causing miosis
∙ Opioids (morphine, hydromorphone, and oxycodone)
∙ Sedative-hypnotics (barbiturates and benzodiazepines)
∙ Cholinergic (nerve agents and organophosphate insecticides)
∙ Sympatholytic (clonidine and oxymetazoline)
Common drugs causing mydriasis
∙ Sympathomimetics (cocaine and caffeine)
∙ Anticholinergics (atropine, scopolamine, and TCAs)
∙ Hallucinogens (LSD, mescaline, and psilocybin)
∙ Serotonin syndrome
Common drugs causing nystagmus
Barbiturates
Carbamazepine
Phencyclidine
Phenytoin
Lithium
It is a procedure where a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean your blood.
Hemodialysis
It is an extracorporeal blood purification modality that consists of the passage of anticoagulated whole blood through a device, usually a column, that contains adsorbent particles
Hemoperfusion
The kidney can rapidly eliminate many water-soluble xenobiotics (exogenous chemicals). However, in the face of extraordinary serum concentrations of these xenobiotics or renal dysfunction, alternative elimination techniques often become necessary.
These techniques are used to increase the clearance of xenobiotics.
Extracorporeal removal (ECR)
Extracorporeal removal (ECR) techniques include
Hemodialysis (HD)
Charcoal hemoperfusion (HP),
and modalities grouped under the heading of continuous renal replacement therapy (CRRT): Continuous venovenous hemofiltration (CVVH)
Continuous venovenous hemodiafiltration (CVVHDF).
It is induced by administering a fluid overload and adiureticconcurrently.
forced diuresis
The primary problems associated with forced diuresis include potential fluid overload and electrolyte abnormalities. The practitioner should monitor for:
hyponatremia
hypokalemia
water intoxication
pulmonary edema
cerebral edema
Additionally, some toxins such as ____ increase the patient’s susceptibility to interstitial pulmonary edema. Forced diuresis is contraindicated in these intoxications.
tricyclic antidepressants and many sedative-hypnotics
The most common diuretics employed are:
furosemide (5 mg/kg every 6 to 8 hours)
mannitol (1 to 2 g/kg IV every 6 hours).
Uses PEG [ Golytely, Colyte] -Dosage:1-2hours [PO or by NGT Indications:
-For poorly absorbed sustance
Whole Bowel Irrigation
binds Cu, Pd, Hg
-hydrolysis product of penicillin
-P.O
Penicillamine [Cuprimine]
-binds iron [Fe]
-IV, IM, SC
Deferoxamine/Deferoxime [Desferal]
-binds Pb, Mn, Zn
-I,V [D5W or NSS] : I.M [Procaine HCl]
Calcium Disodium Edetate [Ca Na2EDTA or Ethylene diamine tetra acetic acid
- I.M
- Binds As, Hg, Pb, Sb, Au
- serves as the metal acceptor and prevents binding of the SH groups of enzymes to metals.
C.I in Fe, Cd,Se
Dimercaprol or BAL [British Antilewisite],
contain electron-donating groups that react with metals to form complexes.
Chelating agents
“universal Antidote”
Activated charcoal
Not absorbed by Activated charcoal
Cyanide
Iron
Ethanol
Lead
Ethylene glycol
Lithium
Mercury
Methanol
Organic solvents
Potassium
Strong acid
Strong alkalis
It is a substance, usually a powder, taken to adsorb gases, toxins, and bacteria in the stomach and intestines.
Examples include activated charcoal and kaolin.
Adsorbents
- Alter the poison by forming an insoluble substance
Precipitants
-Induce evacuation of bowel like Magnesium salts, Sugar alcohol [sorbitol], senna
Cathartics
Syrup of Ipecac Age and Dose
6-9 months - 5 ml
9-12 months - 10 ml
1-12 years - 15 ml
> 12 years - 30 ml
Used for patients who are seen early following massive ingestions.
- Patients who are unconscious or with diminished gag reflex.
Gastric Lavage
- Prevents the absorption of the poison
Mechanical antidotes
Change the chemical nature of poison
Ex: sodium thiosulfate which converts cyanide into non-toxic SCN.
Chemical Antidote
one that produced an opposite effects as that of the poison.
Ex: [Caffeine-Ethanol or diazepam],[Atropine- Physostigmine],[INH- Pyridoxine]
Physiological Antidote
General Antidotes
Physiological Antidote
Chemical Antidote
Mechanical Antidote
Dermal Exposure
Remove the contaminated materials from patient
Slightly cool water
Ocular Exposure
NSS irrigation for 15 minutes
Inhalation Exposure [One of the most dangerous]
Treatment: Rapid removal from environment
If needed: 100% oxygen, assisted ventilation, bronchodilators
